Background:
The initial phases of the COVID-19 pandemic posed a real need for
clinicians to identify patients at risk of poor prognosis as soon as possible after hospital admission.
Aim:
The study aimed to assess the role of baseline anamnestic information, clinical parameters,
instrumental examination, and serum biomarkers in predicting adverse outcomes of COVID-19
in a hospital setting of Internal Medicine.
Methods:
Fifty-two inpatients consecutively admitted to the Unit of Internal Medicine “Baccelli,”
Azienda Ospedaliero – Universitaria Policlinico of Bari (February 1 - May 31, 2021) due
to confirmed COVID-19 were grouped into two categories based on the specific outcome:
good prognosis (n=44), patients discharged at home after the acute phase of the infection; poor
prognosis, a composite outcome of deaths and intensive care requirements (n=8). Data were
extracted from medical records of patients who provided written informed consent to participate.
Results:
The two study groups had similar demographic, anthropometric, clinical, and radiological
characteristics. Higher interleukin 6 (IL-6) levels and leucocyte count, and lower free triiodothyronine
(fT3) levels were found in patients with poor than those with good prognosis. Higher
IL-6 levels and leucocyte count, lower fT3 concentration, and pre-existing hypercholesterolemia
were independent risk factors of poor outcomes in our study population. A predicting risk
score, built by assigning one point if fT3 < 2 pg/mL, IL-6 >25 pg/mL, and leucocyte count
>7,000 n/mm3, revealed that patients totalizing at least 2 points by applying the predicting score
had a considerably higher risk of poor prognosis than those with scoring <2 points [OR 24.35
(1.32; 448), p = 0.03]. The weight of pre-existing hypercholesterolemia did not change the risk
estimation.
Conclusion:
Four specific baseline variables, one anamnestic (pre-existing hypercholesterolemia)
and three laboratory parameters (leucocyte count, IL-6, and fT3), were significantly associated
with poor prognosis as independent risk factors. To prevent adverse outcomes, the updated
4-point score could be useful in identifying at-risk patients, highlighting the need for specific
trials to estimate the safety and efficacy of targeted treatments.
